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Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial.

ABSTRACT: Depression is a common and disabling condition. In Chile, assistance is guaranteed by law through a national program for depression in primary care services, and there is evidence of effective treatment for depressed women. However, there is a shortage of evidence-based treatments for depression in adolescents. The incorporation of technology to expand therapeutic options is becoming more common. This proposal aims to compare the efficacy of therapy that enhances traditional face-to-face cognitive-behavioral therapy (CBT) with a computer-based program versus usual care to treat depression in adolescents in primary care clinics in Santiago, Chile.This is a two-arm, single-blind, randomized controlled trial with a target enrollment of 216 depressed adolescents between 15 and 19 years of age, attending four primary care clinics in Santiago, Chile. In the active arm, depressed adolescents will receive eight sessions of computer-assisted CBT, led by trained psychologists on a weekly basis. In the control arm, depressed adolescents will receive treatment as usual from the primary care centers. Mean depression scores and indicators of dysfunctional thoughts, problem-solving strategies, and health-related quality of life will be measured at baseline and four and six months after randomization.As far as we know, this is the first randomized controlled trial of a computer-assisted CBT intervention for depressed adolescents in a Latin American country.Clinical Trials: NCT01862913.

SUBMITTER: Martinez V

PROVIDER: S-EPMC4132907 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial.

Martínez Vania V Martínez Pablo P Vöhringer Paul A PA Araya Ricardo R Rojas Graciela G

Trials 20140805

<h4>Background</h4>Depression is a common and disabling condition. In Chile, assistance is guaranteed by law through a national program for depression in primary care services, and there is evidence of effective treatment for depressed women. However, there is a shortage of evidence-based treatments for depression in adolescents. The incorporation of technology to expand therapeutic options is becoming more common. This proposal aims to compare the efficacy of therapy that enhances traditional f ...[more]

PMID: 25091593

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Project description:Introduction: Evidence from developed countries shows the efficacy of computer-assisted cognitive-behavioral therapy (cCBT) in addressing adolescent depression in home and/or school settings. This paper presents the results of a randomized controlled trial (RCT) of a brief therapist-guided cCBT intervention for adolescent depression in resource-constrained primary health care (PHC) settings. Material and methods: A multicenter, two-arm parallel-group, individually RCT with a 1:1 allocation ratio assigned 216 depressed adolescents (aged 15-19) attending four PHC centers in a low-income municipality of Santiago, Chile, to receive eight weekly face-to-face therapist-guided cCBT sessions by study therapists (N = 108), or to receive an enhanced usual care (EUC) intervention by trained PHC psychologists, encouraged to adhere to the national clinical guidelines for the management of depression (N = 108). Both groups received pharmacotherapy concordant with these guidelines. The primary outcome was the Beck Depression Inventory (BDI) at 4 months post-randomization, to assess depressive symptoms. BDI at 6 months post-randomization was a secondary outcome. Additional measures included patients' compliance, and satisfaction with different treatment components, at 6 months post-randomization. Main Results: The adjusted difference in mean BDI score between groups was -3.75 (95% CI -6.23 to -1.28; p = 0.003) at 4 months post-randomization. At 6 months post-randomization, the adjusted difference in mean BDI score between groups was -2.31 (95% CI -4.89 to 0.27; p = 0.078). The effect size was small-to-medium at 4 months post-randomization, d = 0.39 (0.12 to 0.67), and small and non-significant at 6 months post-randomization d = 0.29 (-0.00 to 0.59). Adolescents in the experimental treatment group were significantly more satisfied with treatment, with the PHC centers' facilities, with the psychological care received, and with non-professional staff than those in the comparator treatment group. Discussion: A brief therapist-guided cCBT eight-session intervention improves the response of depressed adolescents attending PHC centers at 4 months post-randomization. At 6 months post-randomization, the differences of between groups were not significant. Future research may focus on exploring strategies to sustain and increase response. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT01862913 and URL: https://clinicaltrials.gov/ct2/show/NCT01862913.

Dataset Information

Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial.

Publications

Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial.

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